Teoria Sistêmica, subsistema do Direito e o novo paradigma da Saúde Única / Systemic Theory, Law subsystem and the new One Health paradigm / La Teoría Sistémica, el sistema del Derecho y el nuevo paradigma One Health

Objetivo: discutir o novo paradigma da Saúde Única à luz da Teoria Sistêmica de Niklas Luhmann e a atuação do subsistema do Direito em face das interconexões da abordagem. Metodologia: tratou-se de um ensaio crítico inédito, com utilização da teoria luhmaniana e os novos conceitos da saúde única. Resultados: a teoria dos sistemas sociais de Luhmann possibilita o subsistema do Direito, em sua autopoiese, além de compreender e passar a operar com as novas abordagens integradas de saúde humana, saúde animal e meio ambiente. Conclusão: o subsistema do Direito está apto a incorporar em sua comunicação interna o novo paradigma, reconhecendo a futura legislação da saúde única.

Objective: to discuss the new One Health paradigm in the light of Niklas Luhmann's Systemic Theory and the performance of the Law subsystem in view of the interconnections of the approach. Methodology: this was an unprecedented critical essay, using Luhmanian theory and the new concepts of single health. Results: Luhmann's theory of social systems enables the subsystem of Law, in its autopoiesis, to understand and begin to operate with the new integrated approaches to human health, animal health and the environment. Conclusion: the Law subsystem can incorporate the new paradigm into its internal communication, recognizing the future single health legislation.

Objetivo: discutir el nuevo paradigma One Health a la luz de la Teoría Sistémica de Niklas Luhmann y el desempeño del subsistema del Derecho frente a las interconexiones del abordaje. Metodología: se trató de un ensayo crítico inédito, utilizando la teoría luhmaniana y los nuevos conceptos de salud única. Resultados: la teoría de los sistemas sociales de Luhmann permite al subsistema Derecho, en su autopoiesis, comprender y pasar a operar con los nuevos enfoques integrados de la salud humana, la salud animal y el medio ambiente. Conclusión: el subsistema del Derecho logra incorporar el nuevo paradigma en su comunicación interna, reconociendo la futura legislación de la salud única.

Antimicrobial resistance in the environment: The Indian scenario

Antimicrobial resistance (AMR) continues to pose a significant public health problem in terms of mortality and economic loss. Health authorities of several countries including India have formulated action plans for its containment. In this fight against AMR, it is important to realize the contribution by all the following four spheres: humans, animals, food and environment. This review incorporates all the spheres of One Health concept from the Indian perspective. India has one of the highest rates of resistance to antimicrobial agents used both in humans and food animals. The environment, especially the water bodies, have also reported the presence of resistant organisms or their genes. Specific socio-economic and cultural factors prevalent in India make the containment of resistance more challenging. Injudicious use of antimicrobials and inadequate treatment of waste waters are important drivers of AMR in India. Use of sludge in agriculture, improper discard of livestock animals and aquaculture industry are considered AMR contributors in other countries but Indian data regarding these are lacking. Efforts to combat AMR have been initiated by the Indian health authorities but are still at preliminary stages. Keeping in view the challenges unique to India, future directions are proposed.

Basic health concept and knowledge and its influencing factors among residents in Xicheng District of Beijing / 预防医学

Objective To realize the status of health literacy on basic health concept and knowledge and its influence factors among the residents in Xicheng District of Beijing, and to provide basis for developing targeted health education in the future. Methods Residents aged 15-69 years in Xicheng District were selected by stratified multi-stage sampling method and investigated using National Health Literacy Questionnaire. The level of basic health concept and knowledge and its influence factors were analyzed. Results We investigated 3462 people and received 3290 valid questionnaires, with 95.03％ efficiency. The rate of having basic health concept and knowledge in residents of Xicheng District was 22.67％, with standardized rate of 24.48％. The rate of having basic health concept and knowledge in males and females were 21.47％ and 23.85％. In all questions of basic health concept and knowledge, the lowest correct answer rate was the route of transmission of tuberculosis, only 10.92％ . Multiple logistic regression analysis showed that occupation (OR: 1.303-2.330) and education level (OR:1.367-2.196) were the influencing factors for basic concept and knowledge of health literacy after other factors have been controlled. Conclusion The level of basic health concept and knowledge in Xicheng District was very low. Occupation and education level were the influencing factors for having basic concept and knowledge of health literacy.

Tensões no conceito de saúde a partir de Nietzsche - a grande saúde e a produção do cuidado / Tensions in the health concept from the idea of Nietzsche's "great health": singular care, resistance to life regulation / Tensiones en el concepto de salud desde la idea de "gran salud" de Nietzsche: el cuidado singular, la resistencia a la regulación de la vida

Este artigo interessa-se em problematizar a noção de saúde em relação a seus significados em referência ao conceito de grande saúde de Nietzsche. A partir de um percurso etimológico procuramos desnaturalizar esse termo que atravessa nosso cotidiano enquanto profissionais, acadêmicos e usuários de serviços assistenciais, a fim de colocar em evidência a que se liga a noção de saúde em seu plano de significação. Propomos a grande saúde como instrumento capaz de interpelar as noções de saúde de forma que se deem a ver as conexões que estas estabelecem com o sistema de valores no qual investimos. A oferta nietzschiana emerge, portanto, como fio tensionador do discurso científico hegemônico sobre saúde ao propor inventar passageiros valores e saúdes possibilitando a experimentação de outros modos de estar no mundo.(AU)

The discussion of health notion plays an essential role in this article. From an etymologic tour, we aim to denaturalize this notion which passes through our daily life as professionals, academics, scientists, politicians and users of the health care services, in order to highlight to what connects the notion of health in its field of signification. Inspired by the Friedrich Nietzsche's concept of great health, we propose to question the health notions so that emerge the connections they established with the value system in which we invest. It is the possibility of thinking the intertwined weft between ideal of man and health definition in the care field. The Nietzschean offer appears, therefore, as a wire tensioning the scientific hegemonic discourse on health by proposing to invent passengers values and healths, enabling experimentation of others ways of being in the world. (AU)

La problematización del concepto de salud tiene un papel central en este artículo. Desde un paseo etimológico buscamos descontruir este concepto que cruza nuestra vida cotidiana mientras profesionales, académicos, científicos, políticos y usuarios de los servicios de salud con el fin de poner en evidencia a que se conecta la noción de salud en su plan de significación. Inspirados por el concepto de gran salud de Friedrich Nietzsche, proponemos cuestionar las nociones de salud para pensar la trama entrelazada entre el ideal de hombre y la definición de salud en el plan decuidado. La oferta de Nietzsche, por lo tanto, surge como un tensor del discurso científico hegemónico en la salud, al proponer inventar pasajeros valores y saludes permitiendo la experimentación de otros modos de estar en el mundo. (AU)

Formação do agente comunitário de saúde na reorganização da atenção primária com perspectiva de mudança do modelo de atenção / Training of community health agent in the reorganization of primary health care with the perspective of changing the health care model

Este estudo buscou analisar a percepção do agente comunitário de saúde sobre a formação recebida e a possibilidade de aplicação/mobilização das competências requeridas para mudanças no processo de trabalho. A educação para o trabalho é considerada uma estratégia para a transformação social, implicando em reformulação de estratégias para tornar os trabalhadores profissionais comprometidos, formando-os em processos educativos direcionados para competências, sob os princípios da humanização e foco no trabalho, lócus em que se evidencia e se desenvolvem as necessidades de reorientação do desempenho do trabalhador de saúde. Para isso buscou-se conhecer as percepções dos ACS, egressos do módulo I, formação inicial do curso técnico de agente comunitário de saúde, em relação aos conceitos de saúde e promoção da saúde, processo de trabalho e competência profissional e formação dos agentes comunitários de saúde. Partiu-se da premissa de que os processos de formação dos Agentes Comunitário de Saúde, não atende às necessidades da comunidade e da estratégia saúde da família, uma vez que em sua maioria ocorrem de forma desarticulada do contexto das práticas. Os sujeitos da pesquisa foram agentes comunitários de saúde egressos do curso de formação inicial em agente comunitário de saúde, integrantes de equipe saúde da família. Trata-se de uma pesquisa qualitativa que teve como instrumento central de coleta de dados o grupo focal e técnicas complementares a observação participante e a análise documental. Os dados obtidos foram analisados de acordo com a técnica de análise de conteúdo proposta por Bardin. Evidencia-se que o conceito de saúde na percepção do ACS, não esta presente a abordagem biomédica, curativa, como ausência de doença, mas há uma ampliação para além ao entender a saúde como um direito fundamental para as condições de saúde e qualidade de vida.

This study aimed at analyzing the health community agent's perception about thetraining received and the possibility of application/mobilization of the competences required for changes in the work process. Education for work is considered a strategy for social changes, implying in reformulation of strategies to make the Professionalworkers become committed, training them in educative processes directed towards competence, under the humanization principle and focused on work, locus where it appears and where the needs are developed for reorientation of the health worker'sperformance. For this purpose, we sought to learn the ACS perceptions, module I graduates, initial training of the technical course of community health agent, in relation to health concepts and health promotion, work process, professional competence andtraining of the community health agents. It started from the premise that the training processes of the Community Health Agents, does not meet the needs of the community and the strategy family health, since most of them occur in a way disconnected from the context of the practices. The subjects of the research were health community agents,students that had finished the beginner's training course in health community agents, belonging to the health family team. It is a qualitative research that had as central tool ofdata collection the focal group and complementary techniques of participant observation and the documental analysis. The data obtained were analyzed according to thetechnique of content analysis proposed by Bardin. The concept of health in the ACS perception, does not present the curative, biomedical approach as absence of the disease, but it goes further when understanding health as a fundamental right for health conditions and quality of life. The social determinants of health (DSS) were considered as the main factors that interfere in the health field and also the need for intersectorial public policies...

¿Qué se entiende: hoy, por “Salud Pública”? / The present meaning of Public Health

Desde 1990 se habla de una “crisis” de la Salud Pública, la cual aparece asociada al reajuste estructural de las economías y a reformas del sector de la salud. Al mismo tiempo, numerosos autores han insistido sobre la determinación económica y social del estado de salud y de la inequidad que lo caracteriza. Esta noción está incorporada a las definiciones de la Salud Pública (SP), las cuales se analizan aquí. Se especifican a continuación los criterios utilizados para reconocer a la Salud Pública como una especialidad de la Medicina y de otras profesiones relacionadas, a saber: como un campo del conocimiento, como un campo de acción y de investigación y como una actividad social y política, entre otras características. Se examinan diversas posiciones acerca de la amplitud del concepto de SP: aquéllas que lo limitan a promoción y prevención, aquellas que lo extienden hacia la reparación de la salud y las que lo amplían en dirección de los factores extrasectoriales. Por otra parte, las organizaciones financieras han interferido en las perspectivas y prácticas recientes de la salud pública, al dar preeminencia a los resultados económicos en el sector, por sobre los resultados en salud. Es necesario elaborar una concepción holística de la SP, basada en la definición de Winslow, que incorpore aspectos de principios; que la vincule a la política de salud y a su aplicación por el Estado, la sociedad civil y los ciudadanos; que incluya el diseño y dirección del sistema de atención; que integre las funciones clásicas del sistema y el conocimiento y preocupación por los factores intra y extrasectoriales de la salud de la poblacióny de las personas. Se analizan los componentes del campo de la Salud Pública y sus relaciones recíprocas, destacando el concepto de Medicina Social y el de las redes de causalidad. Se destaca el aspecto valórico de la SP y su presencia en la historia. El artículo se refiere a otras publicaciones de la serie Bases de la Salud Pública, de Cuader...

Starting around 1990, we hear about a “crisis” of Public Health, in connection with the structural adjustmentsof national economies and with health sector reforms. At the same time, the social determinants of health andof inequities in health receive a particular emphasis. The notion of the social determination of health belongsin the classical definitions of Public Health, which are analyzed in this paper.Criteria for the recognition of Public Health as a branch of Medicine and related professions are specified, v.gr.: it is an area of knowledge; it is a field of action and research; it is social and political activity; and so on. Issues related to the scope of Public Health are reviewed: for example, the viewpoint that restricts it to the functions of health promotion and sickness prevention; its extension to include the treatment and rehabilitation functions; and its extension towrds extrasectorial determinants. It is noted that financial organizations have interfered in recent times with the perspectives and practice of Public Health, by assigning preeminence to economic results over health results. A holistic concept of Public Health is required. This may be based on C.E.Winslow’ s and other classical definitions which are brought together at the beginning of the paper.We suggest adding to them such elements as: the underlying concepts of “human being” and of human and environmental health; the principles of equity, effectiveness and efficiency; the relatinship with health policy and its implementation by the Satate, civil society and the citizens; the design and conduction of the health care system; the integration of the classical functions of the system; and the awareness abd concern for the intra and extrasectorial factors of the health of personsand populations. The components in the Public Health field, and their mutual relationships, are analyzed. In this context, both the Social Medicine concept and the causation networks in...

Ideas, creencias y percepciones acerca de la salud: reseña histórica / Ideas, beliefs and perceptions about health: a historical account

Con el objeto de tener una aproximación más universal al concepto de salud se analizan las ideas, creencias y percepciones documentadas en la historia de las culturas dominantes en el mundo oriental y occidental. Se exponen las contribuciones de filósofos, médicos y pensadores, respecto a las sustancias, fuerzas y principios biológicos elementales del organismo que intervienen en la vida y el destino del hombre. El análisis de estas contribuciones permite reconocer que en diversas culturas se ha definido la salud con términos cuyo significado equivale a las palabras: equilibrio, armonía, equidad, mientras la enfermedad se ha descrito con los antónimos de estos vocablos. Se piensa que la teoría ecológica de la "resilencia", para estudiar la capacidad de adaptación de ecosistemas, puede orientar las ideas en investigaciones fisiológicas de los procesos que conducen al organismo a una nueva condición estable con el medio externo, para conocer el margen impreciso que separa la salud de la enfermedad.

To get a closer approach to the concept of health, this paper reviews the ideas, beliefs, and perceptions about health that have been accepted by Eastern and Western cultures. Health conceptions by philosophers, physicians, and thinkers are presented, particularly as they relate to substances, forces, and elementary biological principles of the human body that determine human life and fate. Analysis of these conceptions makes it possible to recognize different definitions of health as a status of balance, harmony, and equity. On the contrary, disease has been defined with the antonyms of health words. The ecological theory of "resilience" may be useful to analyze the adaptive capacity of ecosystems and to suggest ideas for physiological research on processes leading the human body to a new status of balance with the external environment, and thus define the blurring boundaries between health and disease.

A Study on Health/Illness Concepts in Hospitalized Children / 아동간호학회지

The purpose of this study was to explore the health and illness concepts of hospitalized children. The subjects were 129 hospitalized children from 3 to 12 years old in one general hospital. Data were collected through semistructured interviews by authors. This study was conducted from Jun. 1, 2000 to Dec. 31, 2000. Data were coded and categorized by content analysis. The results were as follows: 1.Perceived health concept were physical well- being, food, exercise, powerfulness, emotional stability, obeidence, cleanliness, sleep and ability of social adaptation. 2. Perceived health behavior to maintain health were food, treatment, exercise, cleanliness, obeidence, sleep, emotional stability, powerfulness and psychological stability, physical well-being. 3.Perceived prevention of illness were food, cleanliness, treatment, exercise, obedience, sleep, powerfulness, psychological stability, emotional stability, recreation and ability of social adaptation. 4.Perceived causes of illness were illness, trauma and food. 5.Perceived treatment of illness were treatment, sleep, rest, food, obedience, emotional stability, psychological stability, cleanliness, exercise and powerfulness.

An Exploratory Study on Late Schooler's Health Concept and Health Behavior / 아동간호학회지

The purpose of this study was to explore the late schooler's health concept and health behavior. The research was a descriptive method using a self-report questionnaire which include semi open-ended questions. the subjects were 4581ate schooler's from 4 to 6 grade. The results were as follows : 1. Perceived health concepts were 'having no illness' 'having normal physical feature and strength' 'eating food well' 'take exercise' 'having a bright mind' 'having good interpersonal relationships' 'having strong will' 'recovering well'. 2. Perceived health behaviors to maintain health were 'taking proper exercise' 'eating proper food' 'maintaining cleanliness' 'taking sufficient rest and sleep' 'having a vigor life and positive thought' 'having good interterpersonal relationships' 'receiving health check and immunization'. 3. Health behaviors carried out at present were 'taking proper exercise' 'eating proper food' 'having a vigor life and positive thought' 'receiving health check an immunization' 'taking supplementary drugs' 'having a regular life' 'maintaining cleanliness' 'maintaining warmth'. 4. Perceived causes of illness were 'taking inproper food' 'uncleanliness' 'insufficient warmth or environment' 'lack of exercise or overexertion' 'irregular life habits' 'contact with germs' 'mental stress'. 5. Perceived treatments of illness were 'having sufficient rest and sleep' 'mental relaxation' 'eating food' 'maintinging cleanliness' 'maintaining . warmth' 'taking supplementary drug' 'receiving medical treatment'.

La medición de salud: perspectivas teóricas y metodológicas / Health measurement: theorical and methodological perspectives

El artículo comprende una revisión de diversas alternativas para la medición de la salud tomando como eje ordenador la evolución histórica del concepto de salud. Esta medición ha respondido al perfil epidemiológico y al desarrollo de la conceptualización e interpretación de la salud. En el transcurso del tiempo se identifica una cada vez mayor ampliación de lo que se entiende por salud. Inicialmente cocmprendía básicamente procesos infecciosos, despues procesos degenerativos y actualmente ambos procesos coexisten y, además de entenderse como multifactoriales, se acepta que el proceso salud-enfermedad es el reflejo del estilo y condiciones de vida. Este ensayo abarca la descripción de los postulados conceptuales en los que se han basado las diferentes formas de medir la salud, sus estrategias, así como algunas de sus limitaciones. Se incluyen cinco grandes rubros: la medición de los indicadores de daño (i.e. morbilidad, mortalidad e invalidez); los indicadoress para describir el perfil de salud de una comunidad; los indicadores socio-médicos, en donde se incluyen los indicadores de salud física y mental así como los del componente social de la salud; los indicadores de salud positiva; finalmente se concluye con una revisión sobre la medición de necesidades de salud. La identificación de la perspectiva en la que se encuentran cada una de las investigaciones en salud pública que se llevan a cabo, es de fundamental importancia ya que éstas repercuten directamente sobre la planeación y evaluación de los servicios y en particular, en la calidad de la atención

The present article consists of a revision of the different ways health has been measured and was ordered according to the historic evolution of the health concept and conditions. The development of health measures has paralleled the changes occurred in the epidemiologic profiles and the many refinements in the conceptualization and interpretation of health. Along the years, the meaning of health has become increasingly wider. Initially, only infectious diseases were considered; later, degenerative proceses were included. Nowadays, health is viewed as multifactorial and as a reflection of the life style and conditions. This essay contains a description of the theoretical postulates upon wick the different health measures are based, their strategies and some of their limitations. It is divided into five main sections: morbidity, disability, and mortality indicators; measures of the health of the populations; sociomedical indicators, including measures of phisical and mental health, as well as of the social component of health, positive health indicators and, finally a revision of measures of health need. It is of the utmost importance to be aware of the perspective uscd in the diferent public health research efforts since it has direct repercussions for the planning and evaluation of the health services and, in particular, for the quality of health care.